Free UKMLA sexual health questions with explanations

C. Secondary syphilis

Secondary syphilis develops 4 to 10 weeks after the primary chancre and classically presents with a generalised maculopapular rash involving the palms and soles, mucous patches (painless white oral lesions), patchy 'moth-eaten' alopecia, condylomata lata, and generalised lymphadenopathy. The history of a preceding painless genital ulcer that resolved spontaneously is characteristic of the primary chancre of Treponema pallidum infection.

E. Treponemal enzyme immunoassay

UK screening uses a treponemal enzyme immunoassay (EIA) or chemiluminescent assay as the initial test because it detects IgG and IgM antibodies to Treponema pallidum with high sensitivity across all disease stages, including asymptomatic latent infection. Reactive screens are confirmed with a second treponemal test such as TPHA/TPLA or another EIA/CLIA, and a non-treponemal test (VDRL/RPR) is then titred for staging and monitoring response to treatment.

D. Treat at least 30 days before delivery and repeat RPR serology at delivery (more often if at risk of reinfection)

Congenital syphilis is largely preventable if maternal treatment with benzathine penicillin is completed at least 30 days before delivery, allowing transplacental treatment of the fetus. Repeat RPR serology at delivery (and more often if there is a risk of reinfection) is advised to detect reinfection; a 4-fold fall may take months and is often not seen before delivery, and a Jarisch-Herxheimer reaction can trigger uterine contractions but is self-limiting and managed supportively.

A. Repeat HPV test in 12 months

Under the NHS Cervical Screening Programme primary HPV testing pathway, a sample positive for high-risk HPV with negative cytology is managed with early recall at 12 months. Two further annual HPV tests are offered if needed; persistent HPV at the 24-month repeat triggers colposcopy. Direct colposcopy is reserved for HPV-positive samples with cytological abnormality. Takeaway: HPV-positive, cytology-negative on NHS primary screening is followed up at 12 months, not by immediate colposcopy.

B. Offer one dose under NHS catch-up

The UK catch-up programme offers free HPV vaccination on the NHS until a person's 25th birthday for those who missed the school programme, regardless of sex. Since 2023 a single nonavalent dose is offered for catch-up under age 25 in immunocompetent individuals. Vaccination before HPV exposure provides the greatest protection, but is still recommended for those already sexually active. Takeaway: NHS HPV catch-up is available up to the 25th birthday at a single dose for immunocompetent recipients.

A. Switch to depot medroxyprogesterone acetate intramuscular injection

Rifampicin is a potent CYP3A4 inducer that markedly reduces serum levels of all hormonal contraceptives metabolised by this pathway, including COCP, POP, patch, ring and implant; contraceptive failure is well documented. Switching to a method unaffected by enzyme inducers is advised: depot medroxyprogesterone acetate, copper IUD, or levonorgestrel IUS. Enzyme induction persists for around 4 weeks after rifampicin discontinuation.

C. Cervical ectropion

Oestrogen causes the columnar epithelium of the endocervical canal to evert onto the ectocervix, where it appears as a smooth red ring around the os because a single layer of columnar cells lets the underlying vessels show through. The exposed columnar epithelium is fragile and mucus-secreting, which explains contact bleeding after intercourse and a clear discharge in a young woman on the combined pill. Chlamydial cervicitis is the main alternative and must be excluded with a swab, but it produces a mucopurulent discharge and a diffusely inflamed, friable cervix rather than a smooth velvety ring. Cervical intraepithelial neoplasia is not visible to the naked eye, and carcinoma is an irregular, friable or ulcerated growth.

E. Test for chlamydia and gonorrhoea

Postcoital bleeding in a sexually active young woman must be assumed to be infective until proven otherwise, because chlamydia causes cervicitis and contact bleeding, is common, and is easily treated, and an ectropion does not prove that the bleeding is benign. A vulvovaginal swab for chlamydia and gonorrhoea is therefore the first step once the cervix has been inspected. If infection is excluded and the bleeding persists, changing away from oestrogen-containing contraception or ablating the ectropion can be considered. Screening is a test for pre-malignant change in asymptomatic women and is not a diagnostic test for bleeding, so it is not repeated early, and colposcopy referral is for an abnormal screening result or a cervix that looks suspicious of cancer.

C. Serum creatinine with estimated glomerular filtration rate

Tenofovir disoproxil can cause proximal tubulopathy and rarely Fanconi syndrome. Baseline serum creatinine and eGFR are recommended, repeated annually in low-risk users (under 40, eGFR 90 or above, no renal risk factors) and 6-monthly or more often in others, with discontinuation considered if eGFR falls below 60 mL/min/1.73 m2. Routine urinalysis for proteinuria is not recommended when baseline renal function is normal.

B. Cryotherapy in clinic

Cryotherapy is the preferred first-line treatment for anogenital warts in pregnancy because the topical agents commonly used in non-pregnant patients are either teratogenic, contraindicated, or have insufficient safety data. Clinic-delivered ablative therapy (cryotherapy or electrosurgery) is recommended where treatment is needed during pregnancy. Many warts also enlarge during pregnancy and may regress postpartum. Takeaway: cryotherapy is the safest first-line treatment for anogenital warts in pregnancy.